Monday, 6 October 2008

The Hippocratic Oath (3)

Let's conclude our discussion on the Hippocratic Oath, continuing to dissect one paragraph at a time.

I will not give a lethal drug to anyone if I am asked, nor will I advise such a plan; and similarly I will not give a woman a pessary to cause an abortion.

Once again, the issue of euthanasia raises its head in the first part of the sentence, and the equally contentious topic of abortions makes up its balance (there's nothing new under the sun!). I have my own opinion on both issues, but I'll save that for a later post; it will suffice to merely flag it here.

In purity and according to divine law will I carry out my life and my art.

It isn't entirely clear what Hippocrates means here, but the gist of it can be apprehended. The specifics of 'divine law' probably need spelling out though, and they have doubtlessly changed radically since the time this Oath was penned.

I will not use the knife, even upon those suffering from stones, but I will leave this to those who are trained in this craft.

This phrase is rather charmingly outdated. 'Suffering from stones' (or sometimes 'labouring under the stone') refers to the belief that most lower abdominal pain was the result of bladder stones. As such, there were barbers (forerunners of surgeons) who would perform what may be charitably described as an 'operation' to remove them. In many ways, the task was seen as a rather inferior duty, unworthy of physicians, but here Hippocrates seems to be walking a path of humility rather than snobbishness.

Into whatever homes I go, I will enter them for the benefit of the sick, avoiding any voluntary act of impropriety or corruption, including the seduction of women or men, whether they are free men or slaves.

In this passage Hippocrates reminds physicians that their primary duty is to heal the sick. Peripheral 'benefits' (financial or otherwise) should never be a deciding factor.

Whatever I see or hear in the lives of my patients, whether in connection with my professional practice or not, which ought not to be spoken of outside, I will keep secret, as considering all such things to be private.

Here the clause of 'patient confidentiality' is broached, although Hippocrates' rationale for it is not given. Was it primarily a moral principle (secrets should not be indiscriminately shared, doctor or not) or was it more of a practical necessity (promising to keep a secret will encourage patients to be more forthright with their information, allowing for more accurate diagnoses)?

So long as I maintain this Oath faithfully and without corruption, may it be granted to me to partake of life fully and the practice of my art, gaining the respect of all men for all time. However, should I transgress this Oath and violate it, may the opposite be my fate.

The conclusion of the Oath is a bit of voluntary 'handcuffing', asking for blessing if one maintains this Oath "faithfully and without corruption", but asking for the reverse if it is 'violated'. Notice the rather immodest reward that is requested for the former: "the respect of all men for all time"!

The Hippocratic Oath is often assumed by the public to be the ultimate distillation of medical ethics. Yet a closer look reveals that its good parts, while still valid, are platitudes, and there are many instances where we moderns can defensibly part moral company with Hippocrates. Like all moral codes, it may well help to remind oneself of the ultimate aim to which we are striving, but that doesn't mean that the moral code should remain unchanged or unchallenged for all time. The Hippocratic Oath will survive for all time due to its historical value, but it is also easy to see why most clinicians world-wide actually don't say the Oath on graduation day, at least in its original form.

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